a yellow pill to help what ails me
June 25, 2009 3:49 PM Subscribe
i am thinking about asking my MD for an antidepressant prescription and would like to know what to ask for.
I had a heart attack a year ago and the "cardiac depression" has just not really lifted, despite working out, spending lots of time outside, eating well, doing social things with friends and family. my wife says she really notices it and my unhappiness is making her unhappy too. my therapy isn't helping either - it makes me internally better adjusted, i think, but not externally, if that makes sense. i also just feel tired all the time, and lazy, and much less motivated than i used to; from what i understand, an antidepressant might help the base causes of these things.
finally, i am on plavix, aspirin, lisinopril, and high doses of niacin. do i need to worry about these things interfering?
I had a heart attack a year ago and the "cardiac depression" has just not really lifted, despite working out, spending lots of time outside, eating well, doing social things with friends and family. my wife says she really notices it and my unhappiness is making her unhappy too. my therapy isn't helping either - it makes me internally better adjusted, i think, but not externally, if that makes sense. i also just feel tired all the time, and lazy, and much less motivated than i used to; from what i understand, an antidepressant might help the base causes of these things.
finally, i am on plavix, aspirin, lisinopril, and high doses of niacin. do i need to worry about these things interfering?
Be sure to tell him about the high-dose niacin. In fact, you might want to search for interactions among the medicines you're already on.
posted by aquafortis at 4:11 PM on June 25, 2009
posted by aquafortis at 4:11 PM on June 25, 2009
Yep, your doc (or a psychiatrist, if your doc makes a referral) will have an opinion about which antidepressant might be good for you to try, and whether there are any interaction issues with the meds you're on.
That said, Wellbutrin has a good reputation for low incidence of side effects. (Personally, I had good luck on Serzone for about 7 years, but I believe it's being phased out of the market.) Also, remember to be patient -- if can take a few weeks to start seeing some results, and it sometimes takes some time beyond that to get the dosage right.
posted by scody at 4:12 PM on June 25, 2009
That said, Wellbutrin has a good reputation for low incidence of side effects. (Personally, I had good luck on Serzone for about 7 years, but I believe it's being phased out of the market.) Also, remember to be patient -- if can take a few weeks to start seeing some results, and it sometimes takes some time beyond that to get the dosage right.
posted by scody at 4:12 PM on June 25, 2009
Don't ask for a specific drug. I'm sick to freaking death of people going to the doctor with a treatment already in mind. That's what pharmacies are for. You go to the doctor because you don't know what you need, not because you do. You don't know jack about pharmacology, let alone psychiatric pharmacology. Ask him what he thinks you need, and if he fudges, ask for a referral to a psychiatrist.
scody is partially right, but her "recommendations" actually point out something more important than that. Yes, do remember to be patient. These things don't work overnight, and it can take months to properly calibrate your dosage. But the issue implied here is that these things are also pretty patient specific, and what works for her may or may not work for you. Which is why you shouldn't be asking us this, you should be asking your psychiatrist.
posted by valkyryn at 4:23 PM on June 25, 2009 [4 favorites]
scody is partially right, but her "recommendations" actually point out something more important than that. Yes, do remember to be patient. These things don't work overnight, and it can take months to properly calibrate your dosage. But the issue implied here is that these things are also pretty patient specific, and what works for her may or may not work for you. Which is why you shouldn't be asking us this, you should be asking your psychiatrist.
posted by valkyryn at 4:23 PM on June 25, 2009 [4 favorites]
Most MDs are not very experienced in proper use of antidepressants, which are a lot more complicated than you may realize. And self-prescribing is even worse.
If you really think you need drug help for depression, you really should ask your MD for a referral to a psychiatrist.
A psychiatrist is an MD.
What I think was meant is: most cardiologists (who would have treated you for a heart attack) are not familiar with antidepressants. That statement may be true.
posted by dfriedman at 4:24 PM on June 25, 2009
Let the physician decide. That said, your cardiologist may be your best bet for referral. He/she probably knows therapists that deal with the depression that frequently comes after cardiac issues.
Best of luck to you.
posted by 6:1 at 4:32 PM on June 25, 2009 [1 favorite]
Best of luck to you.
posted by 6:1 at 4:32 PM on June 25, 2009 [1 favorite]
Psychiatrists are generally the ones to rely on. Fluxetine is a generic-brand SSRI and it works wonders, but then again I'm not familiar with the other options so I can't evaluate. Your psychiatrist/MD will know what's best for you.
posted by alon at 4:39 PM on June 25, 2009
posted by alon at 4:39 PM on June 25, 2009
Would not recommending anti-depressants without a corresponding support program like cognitive-behavioral therapy. I know a lot of MD's subscribe antidepressants without anything more than a cursory mention of therapy follow up but it is pretty widely acknowledged that your chance of success is many times greater when prescribed medications are coupled with an ongoing therapy program. Change therapists if needed until you find one with the right empathy for your situation.
posted by Muirwylde at 4:40 PM on June 25, 2009
posted by Muirwylde at 4:40 PM on June 25, 2009
One thing you might want to keep in mind is that some of these medications are a lot more sedating/fatiguing than others, though the effects vary a lot from person to person. Since this is already an issue for you now, you may probably want to mention this concern to your doctor as it may help him/her choose a medication that's more appropriate for you. Good luck!
Be sure to your doctor and your pharmacist what other medications you're already taking. Both of them, especially the pharmacist, can advise you on potential interactions.
posted by zachlipton at 5:10 PM on June 25, 2009
Be sure to your doctor and your pharmacist what other medications you're already taking. Both of them, especially the pharmacist, can advise you on potential interactions.
posted by zachlipton at 5:10 PM on June 25, 2009
Don't ask for a specific drug, but rather a recommendation to a psychiatrist who can figure out what's the right medication/therapy for you. Depression is common, but treating it requires an individualized plan that's designed for You. Seriously. When it comes to depression, you really are a special snowflake. For example, like scody, I had good luck on serzone, but enough people had serious liver problems that it is being phased out. I also had migraines on Prozac.
When you get that recommendation, definitely write down all your current medications.
posted by misha at 5:14 PM on June 25, 2009
When you get that recommendation, definitely write down all your current medications.
posted by misha at 5:14 PM on June 25, 2009
Agreeing with the others recommending that you see a psychiatrist rather than an internal med person or your cardiologist. You're more likely to get it resolved quickly if you see someone whose full-time job is to manage depression. Anecdote: my dad is a psychiatrist and he often grumbles about cleaning up the messes left by other MD's who have no idea about anti-depressants or recognizing the difference between depression and other mood disorders.
posted by *s at 5:46 PM on June 25, 2009
posted by *s at 5:46 PM on June 25, 2009
before you start taking ANY antidepressant do your home work on the side-effects, and even more important, the relative difficulty of getting off the meds. Some antidepressants are very difficult to get off of without serious physical/mental impact.....
posted by HuronBob at 5:52 PM on June 25, 2009
posted by HuronBob at 5:52 PM on June 25, 2009
I only want to add - with ANYONE (much less with underlying other health issues) there is a lot of trial and error in what antidepressant works best. What works for me may not work for you, and no one really knows why (though they have some guesses, and some suggestions, those are not by any means...formal).
So:
1. Do listen to the GPs suggestion, if he/she has one, and keep an open mind to it; if the GP doesnt seem to know, NO SHAME in seeing a psychiatrist - you deserve to be living your best life, and the pyschiatrist will know better what to start with, and what to do next if it doesnt work as well as it could be.
2. Don't feel hopeless or frustrated if the first-try drug, no matter how you arrive at the decision on which it is to be, doesnt do the trick. I know people who swear Prozac is best, others who think nothing but Wellbutrin works, for me, Zoloft is best. It's trial and error; the chances of the first pick being the best-for-you pick are not great.
Good luck, and kudos for taking the step...
posted by bunnycup at 6:46 PM on June 25, 2009
So:
1. Do listen to the GPs suggestion, if he/she has one, and keep an open mind to it; if the GP doesnt seem to know, NO SHAME in seeing a psychiatrist - you deserve to be living your best life, and the pyschiatrist will know better what to start with, and what to do next if it doesnt work as well as it could be.
2. Don't feel hopeless or frustrated if the first-try drug, no matter how you arrive at the decision on which it is to be, doesnt do the trick. I know people who swear Prozac is best, others who think nothing but Wellbutrin works, for me, Zoloft is best. It's trial and error; the chances of the first pick being the best-for-you pick are not great.
Good luck, and kudos for taking the step...
posted by bunnycup at 6:46 PM on June 25, 2009
Antidepressants are the ultimate in YMMV; what works for one person won't work for another, and side effects vary from person to person. If you have any blood relatives who have had depression and taken medications, ask them about their experiences. (A decent doctor will ask you about this too.)
Crazy Meds is an informative resource on the effects of most antidepressants on the market, though it shouldn't be a substitute for your doctor's advice.
Consider asking both your MD and your therapist to recommend a psychiatrist for you. A GP can prescribe something for you, and it might work, but a psychiatrist will have more expertise. Your therapist will also have an informed opinion on whether you'd be a good candidate for medication.
posted by Metroid Baby at 6:52 PM on June 25, 2009
Crazy Meds is an informative resource on the effects of most antidepressants on the market, though it shouldn't be a substitute for your doctor's advice.
Consider asking both your MD and your therapist to recommend a psychiatrist for you. A GP can prescribe something for you, and it might work, but a psychiatrist will have more expertise. Your therapist will also have an informed opinion on whether you'd be a good candidate for medication.
posted by Metroid Baby at 6:52 PM on June 25, 2009
Please go see a psychiatrist. Don't ask for a specific med: it may not be appropriate for you! Don't ask your primary care physician to prescribe something for you: many primary care physicians don't know about the pros and cons of each of the anti-depressants (unsurprising, because that's a psychiatrist's job.) Do make sure you keep everyone - primary care physician, psychiatrist, cardiologist, pharmacist, etc. - up to date on what medications and supplements you're taking. You're already taking a few medications and you definitely want to make sure you're not going to get any nasty interactions and side effects.
The warnings above regarding the weeks of ramp-up and dosage calibration needed for most anti-depressants (and the fact that you may need to try several to find one that works for you) are very important. This is a slow process, and a frustrating one.
You may also benefit from a different kind of therapy, or simply a different therapist. Cognitive behavioral therapy (CBT) is often recommended for people who have depression. Most studies show the best outcomes for someone who's pursuing both meds and therapy.
posted by ubersturm at 7:01 PM on June 25, 2009 [1 favorite]
The warnings above regarding the weeks of ramp-up and dosage calibration needed for most anti-depressants (and the fact that you may need to try several to find one that works for you) are very important. This is a slow process, and a frustrating one.
You may also benefit from a different kind of therapy, or simply a different therapist. Cognitive behavioral therapy (CBT) is often recommended for people who have depression. Most studies show the best outcomes for someone who's pursuing both meds and therapy.
posted by ubersturm at 7:01 PM on June 25, 2009 [1 favorite]
i have a good four year's worth of anti-depressant use under my belt and i've definitely got a lot of opinions about those little buggers. people have very different thoughts about them, and these are mine (i'm sure many people will disagree):
nthing the idea to see an actual psychiatrist and not a gp. they know more about this stuff, period. that's their job. i don't think anyone should initially get a rx for an a.d. from a gp.
nthing not asking for a specific drug. it's not like going to the salon and asking for bangs. everyone reacts very differently to these drugs (tho i guess they react differently to bangs too). psychiatrists don't even know how you'll react -- they can make educated guesses, but they don't really know.
however . . .
in my opinion, people should avoid taking anti-depressants until they feel that it is absolutely necessary. you seem to feel that you are at that point. but huronbob is absolutely right -- getting off these things can be hell, and many psychiatrists don't tell you that (which i believe is incredibly negligent). they also leave you on them way longer than you should be. many times meds will be described by psychs as a temporary aid, but i guarantee you that there are very few of them that, after some time has passed, would say it's time to start going off of them.
let me describe to you some of the side-effects of going off these drugs, which i am now doing after 4-5 years. i am on lexapro. this is touted as being one of the drugs with the fewest side-effects. mind you, you don't have to be going off the drug to feel these effects -- if you miss a dose you can feel these as well. two words: brain shivers. sound bad? they are. it literally feels like a gentle wave of electricity is traveling thru your brain (the longer you go without a dose the less gentle it gets). nausea, dizzyness, extreme lethargy. a general fuzziness, like you're living life behind a thick veil. also a sense of being disconnected, as if watching your life and not living it. after some time i started to feel some of these side-effects even when i'd taken my medicine religiously. that's when i knew i had to get off of them. some people experience side effects of anti-depressant cessation months -- even years -- after going off of them. they are not something to be taken lightly.
for a long time i credited the lexapro with the turnaround of my mood and my life (i was suffering extreme, suicidal depression). now i'm not so sure. research has come out that anti-depressants work about as well as placebos on severely depressed people. in lightly and moderately depressed people, they work about as well as exercise. scientists are also unable to show that depressed people actually suffer from a "chemical imbalance".
i was in therapy (using cbt and dbt methods) while taking the drugs, and i also began practicing meditation. so i can't really say how much of my happiness is due to the drugs.
have you wondered if one or more, or the combination, of the drugs you are now taking could be contributing to your depression -- or even be the cause of it? i know going off of them may not be an option, but adding another drug may not be helpful either. maybe there are different varieties of those drugs that you could take? have you told your cardiologist about your mood? perhaps s/he has encountered this in other patients and a simple tinkering of what you're already on could help. it sounds like your depression is more of a "lack of energy" than a "i hate life" kind of depression, and taking a bunch of medications can definitely affect your energy level.
lexapro might have saved my life. the very chance that they did makes me glad (begrudgingly) that i took them, even with the difficulties i'm having getting off of them. but in my opinion, anti-depressants are to be avoided until the severity of your symptoms makes it worth the risk of taking them.
posted by imalaowai at 7:11 PM on June 25, 2009
nthing the idea to see an actual psychiatrist and not a gp. they know more about this stuff, period. that's their job. i don't think anyone should initially get a rx for an a.d. from a gp.
nthing not asking for a specific drug. it's not like going to the salon and asking for bangs. everyone reacts very differently to these drugs (tho i guess they react differently to bangs too). psychiatrists don't even know how you'll react -- they can make educated guesses, but they don't really know.
however . . .
in my opinion, people should avoid taking anti-depressants until they feel that it is absolutely necessary. you seem to feel that you are at that point. but huronbob is absolutely right -- getting off these things can be hell, and many psychiatrists don't tell you that (which i believe is incredibly negligent). they also leave you on them way longer than you should be. many times meds will be described by psychs as a temporary aid, but i guarantee you that there are very few of them that, after some time has passed, would say it's time to start going off of them.
let me describe to you some of the side-effects of going off these drugs, which i am now doing after 4-5 years. i am on lexapro. this is touted as being one of the drugs with the fewest side-effects. mind you, you don't have to be going off the drug to feel these effects -- if you miss a dose you can feel these as well. two words: brain shivers. sound bad? they are. it literally feels like a gentle wave of electricity is traveling thru your brain (the longer you go without a dose the less gentle it gets). nausea, dizzyness, extreme lethargy. a general fuzziness, like you're living life behind a thick veil. also a sense of being disconnected, as if watching your life and not living it. after some time i started to feel some of these side-effects even when i'd taken my medicine religiously. that's when i knew i had to get off of them. some people experience side effects of anti-depressant cessation months -- even years -- after going off of them. they are not something to be taken lightly.
for a long time i credited the lexapro with the turnaround of my mood and my life (i was suffering extreme, suicidal depression). now i'm not so sure. research has come out that anti-depressants work about as well as placebos on severely depressed people. in lightly and moderately depressed people, they work about as well as exercise. scientists are also unable to show that depressed people actually suffer from a "chemical imbalance".
i was in therapy (using cbt and dbt methods) while taking the drugs, and i also began practicing meditation. so i can't really say how much of my happiness is due to the drugs.
have you wondered if one or more, or the combination, of the drugs you are now taking could be contributing to your depression -- or even be the cause of it? i know going off of them may not be an option, but adding another drug may not be helpful either. maybe there are different varieties of those drugs that you could take? have you told your cardiologist about your mood? perhaps s/he has encountered this in other patients and a simple tinkering of what you're already on could help. it sounds like your depression is more of a "lack of energy" than a "i hate life" kind of depression, and taking a bunch of medications can definitely affect your energy level.
lexapro might have saved my life. the very chance that they did makes me glad (begrudgingly) that i took them, even with the difficulties i'm having getting off of them. but in my opinion, anti-depressants are to be avoided until the severity of your symptoms makes it worth the risk of taking them.
posted by imalaowai at 7:11 PM on June 25, 2009
Drug interactions: The typical first-line antidepressants, SSRI's, can have significant drug interactions, but several drugs in the class do not. Your prescriber needs to know everything you are on to prescribe correctly.
Beyond that, as much as I love discussing medical issues on MeFi, you should not be relying on us to tell you what to ask for. You should discuss with your doctor, get a referral to a psychiatrist with whom he/she has worked in the past, and have them prescribe the appropriate medication after a proper workup.
posted by davidnc at 7:45 PM on June 25, 2009 [2 favorites]
Beyond that, as much as I love discussing medical issues on MeFi, you should not be relying on us to tell you what to ask for. You should discuss with your doctor, get a referral to a psychiatrist with whom he/she has worked in the past, and have them prescribe the appropriate medication after a proper workup.
posted by davidnc at 7:45 PM on June 25, 2009 [2 favorites]
While I agree with the caution against going in and asking for a specific drug, I do think it can be very helpful to be very explicit about what you are feeling and what you are looking for out of the drug. There are times where you would think that a MD would make certain assumption about your goals and your cost benefit analysis, but that doesn't end up happening.
For example, you might want to emphasize:
- you feel tired and lazy, so you'd like to consider antidepressants that are more energizing.
- you're not in crisis, so you want to go with a slow, conservative dosage increase schedule.
- any other specific goals or preferences you have for the therapy or any side effects that would be absolute deal-breakers.
These may not be your goals, (though I would argue for the low-dose-wins approach) but the point is that you don't know enough to pick your drug. What you do know, however, that the MD cannot, is your mindset, and your goals. You need to speak up and communicate those to whoever prescribes for you. And as stated above a psychiatrist is way more likely than a cardiologist to have the expertise to best match your goals/needs/desires to the right drug at the right dose.
posted by mercredi at 8:21 PM on June 25, 2009 [2 favorites]
For example, you might want to emphasize:
- you feel tired and lazy, so you'd like to consider antidepressants that are more energizing.
- you're not in crisis, so you want to go with a slow, conservative dosage increase schedule.
- any other specific goals or preferences you have for the therapy or any side effects that would be absolute deal-breakers.
These may not be your goals, (though I would argue for the low-dose-wins approach) but the point is that you don't know enough to pick your drug. What you do know, however, that the MD cannot, is your mindset, and your goals. You need to speak up and communicate those to whoever prescribes for you. And as stated above a psychiatrist is way more likely than a cardiologist to have the expertise to best match your goals/needs/desires to the right drug at the right dose.
posted by mercredi at 8:21 PM on June 25, 2009 [2 favorites]
Definitely a psychiatrist and not a gp. Your meds need to be monitored and adjusted, and possibly changed, over the course of several months, to find the best thing for you with the least side effects. Your GP is not going to be able to do that for you.
posted by sully75 at 9:57 PM on June 25, 2009
posted by sully75 at 9:57 PM on June 25, 2009
Cardiac events are profoundly life-changing. You are right to recognize what you are going through and to seek help. It sounds like you have been on the right track so far.
Did you do cardiac rehab? If not please talk with your cardiologist about getting into a cardiac rehab program.
You are not alone in your thoughts and feelings. A good cardiac rehab program will address these, plus involve your wife. Sometimes spouses or caretakers don't recognize the event for what it's worth and have unrealistic expectations about life after a heart attack.
If you have already done cardiac rehab, or otherwise think that won't work, tell your cardiologist about what's going on, and ask if he/she thinks a visit with a psychiatrist isn't out of the question.
You also may want to try talk therapy for a few sessions first to see if that helps you.
But I would avoid going in to say "I am depressed and I want Zoloft/Lexapro/etc." That may not be the best solution for you at this time.
Best of luck!
posted by FergieBelle at 4:58 AM on June 26, 2009
Did you do cardiac rehab? If not please talk with your cardiologist about getting into a cardiac rehab program.
You are not alone in your thoughts and feelings. A good cardiac rehab program will address these, plus involve your wife. Sometimes spouses or caretakers don't recognize the event for what it's worth and have unrealistic expectations about life after a heart attack.
If you have already done cardiac rehab, or otherwise think that won't work, tell your cardiologist about what's going on, and ask if he/she thinks a visit with a psychiatrist isn't out of the question.
You also may want to try talk therapy for a few sessions first to see if that helps you.
But I would avoid going in to say "I am depressed and I want Zoloft/Lexapro/etc." That may not be the best solution for you at this time.
Best of luck!
posted by FergieBelle at 4:58 AM on June 26, 2009
please get a referral to a psychiatrist. non-specialists aren't up-to-date on the literature and studies, and you can waste a lot of time getting to something that works. good luck.
posted by thinkingwoman at 3:32 PM on June 26, 2009
posted by thinkingwoman at 3:32 PM on June 26, 2009
non-specialists aren't up-to-date on the literature and studies
Very true. Unfortunately, sometimes even the specialists aren't up-to-date on the literature and studies, as I discovered when I started reading up on the connection between birth control pills and depression. AFAICT, none of the professionals involved in my healthcare — not my GP, my psychiatrist, my therapist, nor anybody in the OB/GYN department — is even aware of this connection (beyond what I've told them about the research... which I don't think any of them have followed up on). If I hadn't done the research myself, I might still be on the Pill and still be suicidal.
In addition to seeing a psychiatrist, I would suggest doing some reading on what the most current research says about cardiac depression. Keeping up on the research helps me feel like I'm being active in understanding and managing my depression, instead of being helpless and relying only on my doctors. And sometimes it means I can do something that really does improve things.
posted by Lexica at 9:32 AM on June 28, 2009
Very true. Unfortunately, sometimes even the specialists aren't up-to-date on the literature and studies, as I discovered when I started reading up on the connection between birth control pills and depression. AFAICT, none of the professionals involved in my healthcare — not my GP, my psychiatrist, my therapist, nor anybody in the OB/GYN department — is even aware of this connection (beyond what I've told them about the research... which I don't think any of them have followed up on). If I hadn't done the research myself, I might still be on the Pill and still be suicidal.
In addition to seeing a psychiatrist, I would suggest doing some reading on what the most current research says about cardiac depression. Keeping up on the research helps me feel like I'm being active in understanding and managing my depression, instead of being helpless and relying only on my doctors. And sometimes it means I can do something that really does improve things.
posted by Lexica at 9:32 AM on June 28, 2009
This thread is closed to new comments.
If you really think you need drug help for depression, you really should ask your MD for a referral to a psychiatrist.
posted by Chocolate Pickle at 3:56 PM on June 25, 2009 [4 favorites]